Managed ventricular pacing compared with conventional dual-chamber pacing for elective replacement in chronically paced patients: results of the Prefer for Elective Replacement Managed Ventricular Pacing randomized study

Botto, Giovanni L.;Ricci, Renato P.;Bénézet, Juan M.;Cosedis Nielsen, Jens;Kozák, Milan;et.al.
(2014) Heart Rhythm — Vol. 11, n° 6, p. 992-1000 (2014)

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Authors
  • Botto, Giovanni L.
    Author
  • Ricci, Renato P.
    Author
  • Bénézet, Juan M.
    Author
  • Cosedis Nielsen, Jens
    Author
  • De Roy, LucUCLouvain
    Author
  • Kozák, Milan
    Author
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Abstract
Background Several studies have shown that unnecessary right ventricular pacing has detrimental effects. Objective To evaluate whether minimization of ventricular pacing as compared with standard dual-chamber pacing (DDD) improves clinical outcomes in patients referred for pacemaker or implantable cardioverter-defibrillator (ICD) replacement. Methods In an international single-blind, multicenter, randomized controlled trial, we compared DDD with managed ventricular pacing (MVP), a pacing mode developed to minimize ventricular pacing by promoting intrinsic atrioventricular conduction. We included patients referred for device replacement with >40% ventricular pacing, no cardiac resynchronization therapy upgrade indication, no permanent atrial fibrillation (AF), and no permanent complete atrioventricular block. Follow-up was for 2 years. The primary end point was cardiovascular hospitalization. The intention-to-treat analysis was performed by using Kaplan-Meier method and the log-rank test. Results We randomized 605 patients (556 referred for pacemaker and 49 referred for ICD replacement; mean age 75 ± 11 years; 365 [60%] men, at 7.7 ± 3.3 years from first device implantation) to MVP (n = 299) or DDD (n = 306). We found no significant differences in the primary end point cardiovascular hospitalization (MVP: 16.3% vs DDD: 14.5%; P =.72) and the secondary end point persistent AF (MVP: 15.4% vs DDD: 11.2%; P =.08), permanent AF (MVP: 4.1% vs DDD: 3.1%; P =.44), and composite of death and cardiovascular hospitalization (MVP: 23.9% vs DDD: 20.2%; P =.48). MVP reduced right ventricular pacing (median 5% vs 86%; Wilcoxon, P <.0001) as compared with DDD. Conclusions In patients referred for pacemaker and ICD replacement with clinically well-tolerated long-term exposure to >40% ventricular pacing in the ventricle, a strategy to minimize ventricular pacing is not superior to standard DDD in reducing incidence of cardiovascular hospitalizations
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Botto, G. L., Ricci, R. P., Bénézet, J. M., Cosedis Nielsen, J., De Roy, L., Piot, O., Quesada, A., Quaglione, R., Vaccari, D., Garutti, C., PreFER MVP Investigators, Vainer, L., & Kozák, M. (2014). Managed ventricular pacing compared with conventional dual-chamber pacing for elective replacement in chronically paced patients: results of the Prefer for Elective Replacement Managed Ventricular Pacing randomized study. Heart Rhythm, 11(6), 992-1000. https://doi.org/10.1016/j.hrthm.2014.01.011 (Original work published 2014)